Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | OR |
NPI | 1134609050 |
---|---|
Provider Name | Andrea P Merryman |
First Address | Salem, OR 97306-9427 |
Second Address | Salem, OR 97306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 20/08/2018 |